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All Contested Case Subject
Jurisdiction
In General
If authorization for treatment is denied on the grounds the treatment is directed towards a condition that has not been accepted and the claimant has not requested acceptance of the condition towards which treatment is directed, there is no dispute over which the WCD can assert jurisdiction and dismissal is proper. Daugherty, Tammy L.*,
16 CCHR 205 (2008).
It is proper for the Workers' Compensation Division to dismiss a dispute where it concerns a request for medical services that are directed to a condition for which the worker has not submitted a claim for acceptance. Daugherty, Tammy L.*,
15 CCHR 286 (2010).
It was proper for the Workers' Compensation Division to dismiss the matter, rather than issue a defer and transfer order, where the requested medical services were directed towards a condition the worker had not asked the insurer to accept, so that there was no causal relationship issue to refer to the Workers' Compensation Board. Daugherty, Tammy L.*,
15 CCHR 286 (2010).
The Workers' Compensation Division has jurisdiction to determine whether or not it has jurisdiction to decide a dispute presented to it. Sloan, Donald G.,
15 CCHR 284 (2010).
The proper resolution where the Workers' Compensation Division determines that it does not have jurisdiction to address the merits of a dispute is to dismiss the action. Sloan, Donald G.,
15 CCHR 284 (2010).
Where an insurer failed to pay a medical bill because it assigned the bill to the wrong claim, but did not dispute the claim or the treatment, the dispute over payment was one concerning payment under ORS 656.248 and was not a medical treatment dispute under ORS 656.245 involving causation, over which the division would not have jurisdiction. Becerra, Evangelina,
15 CCHR 267 (2010).
The case was properly dismissed for lack of justiciable controversy, where WCD could not issue a binding decision regarding claimant's possible liability for medical services. Gonzalez, Juvenal,
15 CCHR 39 (2010).
The case was properly dismissed for lack of "justiciable" controversy, where the appeal was limited to challenging a statement in WCD's order that was outside the scope of the case. Gonzales, Juvenal*,
15 CCHR 1 (2010).
The director had jurisdiction to abate the administrative order, before the order became final by operation of law. Fonseca-Domingues Antonio,
14 CCHR 193 (2009).
The director did not err in dismissing claimant's request for administrative review regarding interim medical benefits where no evidence existed that claimant had a health benefit plan and no evidence existed that the director had jurisdiction to consider the matter since the denial was unappealed. Monroe, Jimmy D,
13 CCHR 101 (2008).
The character of the issues raised in the order does not change simply because the issues have been appealed to the WCB for review. Flower, Michael L,
12 CCHR 264 (2007).
The director lacks authority to order an employer to pay for medical services for a denied condition that was the subject of a disputed claim settlement. Swingle, Deborah,
11 CCHR 292 (2006).
WCD does not have jurisdiction to resolve payment of a disputed medical bill, when the disputed service was performed after the date the claim was denied. Swingle, Deborah*,
11 CCHR 204 (2006).
A request for hearing by a medical service provider who is not the provider seeking payment of bills is without standing and jurisdiction. Sherrel, Karen,
9 CCHR 226 (2004).
WCD has jurisdiction over a vocational eligibility dispute following approval of a CDA. Frazier, OC III,
7 CCHR 59 (2002).
MCO
WCD has jurisdiction to consider all issues pertaining to a disagreement about medical services within an MCO. Henry, James W.,
10 CCHR 433 (2005).
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